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Abstract
Background and Aims Several pain management guidelines recommend administration of analgesics based on patients’ numeric rating scale(NRS) scores. This study aimed to identify which threshold patients prefer to receive analgesics with and without the risk of postoperative nausea and vomiting(PONV) in the post anaesthetic care unit(PACU).
Methods This study was approved by the institutional Ethics Committee. Patients scheduled for elective surgery under general anaesthesia were screened between August 2019 and April 2022. Immediately after awakening from anaesthesia, patients were asked to score their pain intensity using the NRS and whether they desired no analgesic, an analgesic with or without the risk of PONV. Receiver Operating Characteristic(ROC) curves were used to assess the specificity and sensitivity of different NRS scores for receiving analgesics. Upon leaving the PACU, patients were asked which NRS score they preferred as a threshold value to receive an analgesic with and without risk of PONV.
Results 120 patients were enrolled. ROC curves show that an NRS threshold of >2 should be used to treat patients with a mild analgesic and of >5 to administer a strong analgesic. In contrast, upon leaving the PACU, patients report a median NRS threshold of 5 to receive a mild analgesic and of 8 to receive a strong analgesic.
Treshold values for the administration of analgesics at the PACU
Receiver operating characteristic (ROC) curve with the sensitivity and specificity for the different NRS cut-off points for a mild analgesic
Receiver operating characteristic (ROC) curve with the sensitivity and specificity for the different NRS cut-off points strong analgesic
Conclusions The thresholds perceived by patients to receive mild or strong analgesics are lower when patients are just awakening, compared to awake patients preferred threshold. We presume that sedatives might influence patients’ ability to assess their need for analgesics.